| NPI | 1790155521 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL12757) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22338) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2020-06-12 |