| NPI | 1588386908 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 41380) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1859611) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2025-05-20 |