| NPI | 1356894166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MA DN1857818) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61982) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2018-03-17 |