| NPI | 1720839293 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN10000862) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 14455) |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2025-07-18 |