| NPI | 1841650777 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 2024-00524) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DR60650631) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2024-04-18 |