| NPI | 1801200514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 30105) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858319) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2022-12-19 |