| NPI | 1134767866 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MO 2019043361) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IL 019.032433) |
| Enumeration Date | 2019-12-12 |
| Last Update Date | 2019-12-12 |