| NPI | 1902923774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN21727) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21727) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2023-09-05 |