| NPI | 1205419355 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 12328725-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 12328725-9921) |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2022-09-22 |