| NPI | 1124250824 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA dn1855294) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 10082) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2022-07-21 |