| NPI | 1215508312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DEN10000164) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME DEN4889) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2024-06-23 |