| NPI | 1144697038 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 32712) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64944) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2024-02-18 |