| NPI | 1225653553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MA DN1858715) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858715) |
| 1223P0300X Dentist Periodontics (Licence: TX 40245) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2024-04-30 |