NPI | 1629575303 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS041772) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS041772) |
171000000X Military Health Care Provider (Licence: PA DS041772) | |
Enumeration Date | 2018-04-10 |
Last Update Date | 2024-05-30 |