| NPI | 1740671882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857729) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058701) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2019-07-29 |