| NPI | 1982151031 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 9533) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32375) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 103516) | |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2023-02-11 |