| NPI | 1275042723 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 37164) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857757) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2025-04-28 |