| NPI | 1063039808 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401417753) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL14387) |
| Enumeration Date | 2020-06-27 |
| Last Update Date | 2023-08-18 |