| NPI | 1255047817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN10000067) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 109323) |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2024-07-29 |