| NPI | 1053929331 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DF12034) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DF12034) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2026-04-15 |