| NPI | 1205309648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125Q00000X Oral Medicine (Licence: CA 104477) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: CA 104477) |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2025-07-07 |