| NPI | 1780645002 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN19743) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 19743) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1857981) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2018-09-10 |