| NPI | 1053175703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN10001240) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 14371) |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2026-08-31 |