| NPI | 1578627535 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 20428) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA DN20428) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2023-08-31 |