| NPI | 1386100949 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: LA 7617)  | 
| Additional Taxonomies | 122300000X Dentist (Licence: LA 7617)  | 
| Enumeration Date | 2019-02-19 | 
| Last Update Date | 2025-02-14 |