| NPI | 1487215257 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DN1858583) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 103820) |
| 122300000X Dentist (Licence: MA 103820) | |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2023-06-25 |