| NPI | 1356681654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA 1859858) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MN S125) |
| 1223P0300X Dentist, Periodontics (Licence: TX 26373) | |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2023-10-01 |