| NPI | 1114188729 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX D22386) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 22386) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2016-03-03 |