| NPI | 1760969885 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1858230) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: RI DEN03388) |
| Enumeration Date | 2018-07-21 |
| Last Update Date | 2019-07-19 |