| NPI | 1497158653 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS042139) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64068) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA DDS64068) | |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2019-06-27 |