| NPI | 1659753598 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857102) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN21338) |
| Enumeration Date | 2015-06-27 |
| Last Update Date | 2016-01-19 |