| NPI | 1700089513 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: IA 08697) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IA 08697) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2014-02-11 |