| NPI | 1972857506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30025966) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DRP 1122) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2019-09-10 |