| NPI | 1861821118 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WI 1002192) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL12097) |
| 1223P0300X Dentist, Periodontics (Licence: MA DL12740) | |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2020-09-11 |