| NPI | 1902219090 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN1857881) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS040345) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2019-12-30 |