| NPI | 1770954240 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL1857367) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 100121615) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2017-02-21 |