| NPI | 1043251507 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 14054) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 8332) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 8332) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2020-04-18 |