| NPI | 1962819185 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NC 09822) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: NC 9822) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2025-08-01 |