| 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 |