| NPI | 1487877288 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 15857) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 55128) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2015-09-21 |