| NPI | 1225750011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859635) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 13523) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2025-01-10 |