| NPI | 1801264296 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN1858204) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 11497) |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2022-06-29 |