| NPI | 1689634404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 056681) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 06323) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 42152) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 6323) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2018-11-27 |