| NPI | 1639502438 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857791) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62790) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2018-07-12 |