| NPI | 1336647783 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL15216) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL 17-641) |
| Enumeration Date | 2018-01-30 |
| Last Update Date | 2023-10-29 |