| NPI | 1609306901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857644) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 04322) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2023-04-03 |