| NPI | 1154874113 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN123696) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001653) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2025-03-04 |