| NPI | 1326457052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 32099) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856681) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2021-01-12 |