| NPI | 1942794730 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 38714) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858062) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2022-10-24 |