| NPI | 1386100949 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 14527) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 14527) |
| Enumeration Date | 2019-02-19 |
| Last Update Date | 2026-06-29 |