| NPI | 1417407248 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 11909) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858187) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2026-03-17 |