| NPI | 1134412307 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 117) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9068) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 059018) | |
| Enumeration Date | 2011-05-22 |
| Last Update Date | 2022-06-29 |