| NPI | 1619528841 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 13054) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858494) |
| Enumeration Date | 2019-09-29 |
| Last Update Date | 2021-06-29 |