| NPI | 1619317039 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901600731) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 1401417771) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901600731) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS039560) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 34699) | |
| Enumeration Date | 2013-06-29 |
| Last Update Date | 2023-01-05 |