| NPI | 1770831190 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DN1858695) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 04672) |
| 122300000X Dentist (Licence: MA DN1858695) | |
| 1223P0300X Dentist, Periodontics (Licence: NH 04672) | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2023-04-10 |