| NPI | 1609317643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857641) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1857641) |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2022-02-23 |