| NPI | 1013493691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL13793) |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2018-10-03 |