| NPI | 1255742169 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 22848) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856764) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2021-10-06 |