| NPI | 1215349188 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 12373) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856858) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2021-08-22 |