| NPI | 1154009744 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: IA 10147) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA 10147) |
| 122300000X Dentist (Licence: IA DDS-10147) | |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2025-04-16 |