| NPI | 1700498631 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN10000024) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 13103) |
| 122300000X Dentist (Licence: FL DN25132) | |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2024-08-29 |