| NPI | 1821502782 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DL13433) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: MA DL13433) |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2018-03-20 |