| NPI | 1801282769 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.025097) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS102193) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401414839) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2023-10-29 |