| NPI | 1265866057 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN4828) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856387) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2023-03-08 |