| NPI | 1629449897 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857751) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001222) |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2018-03-17 |