| NPI | 1871150060 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DN1859122) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859122) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2024-08-27 |