| NPI | 1124705785 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN10001631) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 14925) |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2026-09-15 |