| NPI | 1912673724 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL15340) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL14937) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2022-08-31 |