| NPI | 1770010043 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN1857916) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02632900) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2018-12-12 |