| NPI | 1942684998 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857055) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL12647) |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2022-08-08 |