| NPI | 1144207135 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 20202) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 53680) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2023-09-19 |