| NPI | 1275116329 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN1859097) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859097) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2024-07-30 |