| NPI | 1316503782 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DN1858720) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 12806) |
| Enumeration Date | 2019-05-11 |
| Last Update Date | 2020-10-28 |