| NPI | 1568134674 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN10001313) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 17511) |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2026-04-27 |