| NPI | 1053322230 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 18104) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9852) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2022-06-13 |