| NPI | 1497744072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PR 2074) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 2074) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2023-02-22 |