| NPI | 1386222784 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN5125) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401418289) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2024-05-09 |