| 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 |