NPI | 1962554428 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 50704) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 042762) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 2867) | |
Enumeration Date | 2007-01-17 |
Last Update Date | 2007-07-08 |