| NPI | 1578280459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: TX 40961) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL15370) |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2024-11-19 |