| NPI | 1710385653 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859500) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL12259) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2023-05-22 |