| NPI | 1851603773 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 26370) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL10980) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2018-04-20 |