| NPI | 1760078307 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1858880) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61086046) |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2021-08-18 |