| NPI | 1134511736 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D012780) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: AZ D012780) |
| 122300000X Dentist (Licence: KY 9664) | |
| 1223X2210X Dentist, Orofacial Pain (Licence: AZ D012780) | |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2026-09-03 |