| NPI | 1356774954 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: WA DE60807266) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN R580) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2023-11-01 |