| NPI | 1790302982 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN4818) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME TBD) |
| Enumeration Date | 2020-07-03 |
| Last Update Date | 2020-07-28 |