| NPI | 1457720104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D11146) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D11146) |
| 1223G0001X Dentist, General Practice (Licence: MA 12753) | |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2022-07-14 |