| NPI | 1871233296 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1859747) |
| Additional Taxonomies | 261QS1000X Clinic/Center, Student Health |
| 122300000X Dentist (Licence: CT 13517) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2026-06-01 |