| NPI | 1902942345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 03617) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA 21618) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2016-10-18 |