| NPI | 1659604346 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN22267) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 13044) |
| 122300000X Dentist (Licence: MA 22267) | |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2018-03-17 |