| NPI | 1992366140 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CA 107888) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: OH RES.004142) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2025-07-17 |