| NPI | 1831748417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 125Q00000X Oral Medicine (Licence: TX 36888) |
| Additional Taxonomies | 125Q00000X Oral Medicine (Licence: MO 2019034508) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 36888) | |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2022-11-21 |