| NPI | 1154783272 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1858174) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 57000026) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2019-03-26 |