| NPI | 1679180897 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MA DN1858828) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858828) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1858828) | |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2023-03-11 |