| NPI | 1942792379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1858901) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00205494) |
| 1223G0001X Dentist, General Practice (Licence: NH 04407) | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2023-04-05 |