| NPI | 1720493265 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA DE61322400) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61322400) |
| 125Q00000X Oral Medicine (Licence: WA DE61322400) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30.024924) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-10-20 |