| NPI | 1104479831 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL15429) |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health (Licence: MA 1223D0001X) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2023-03-02 |