| NPI | 1760835771 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857686) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DL12993) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2023-07-24 |