| NPI | 1710544051 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1858267) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D010647) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2021-02-24 |