| NPI | 1689308835 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 40410) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859575) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2024-07-19 |