| NPI | 1396293916 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857442) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 04260) |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2020-07-01 |