| NPI | 1104143833 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4301111526) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 4301111526) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 4301111526) | |
| 208600000X Surgery (Licence: MI 4301111526) | |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2020-11-19 |