| NPI | 1831598994 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID D5313) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS040156) |
| 1223G0001X Dentist, General Practice (Licence: CA 64497) | |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2022-12-07 |