| NPI | 1659756252 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL13493) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL12643) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2018-03-17 |