| NPI | 1215328356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL dn23958) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858216) |
| 1223E0200X Dentist, Endodontics (Licence: MA DN1858216) | |
| 1223G0001X Dentist, General Practice (Licence: MA DN1858216) | |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2022-06-20 |