| NPI | 1629597562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30.027873) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME DEN4589) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA 106194) | |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2025-04-18 |