| NPI | 1558761585 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV S2-180) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS-041228) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2022-06-10 |