NPI | 1861075160 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN1858911) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DM1858911) |
Enumeration Date | 2021-05-04 |
Last Update Date | 2023-06-30 |