| NPI | 1972857506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30.025966) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.025966) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2026-05-11 |