| NPI | 1558887232 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1858838) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858838) |
| 122300000X Dentist (Licence: MA DL13339) | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2021-01-05 |