| NPI | 1790040749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: AZ D008096) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D008096) |
| 125Q00000X Oral Medicine (Licence: AZ D008096) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2021-08-18 |