| NPI | 1760939300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857745) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL 12987) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2022-07-21 |