| NPI | 1467808790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MI 2901601520) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AL 6348) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2022-09-11 |