| NPI | 1982016812 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS042498) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS042498) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MD 15775) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2021-03-18 |