| 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 |