| NPI | 1861486458 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA DE00008709) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WA MD00038252) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2025-10-23 |