| NPI | 1902097025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA MD60711004) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA D-9493) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WA DE60713032) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2025-10-23 |