| NPI | 1174045454 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DF11761) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DF11579) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-08 |
| Last Update Date | 2021-11-04 |