| NPI | 1821724956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL15266) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA DL15266) |
| Enumeration Date | 2022-07-29 |
| Last Update Date | 2022-08-16 |