| NPI | 1124583323 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: CA 103511) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60809187) |
| Enumeration Date | 2019-02-01 |
| Last Update Date | 2021-11-29 |