| NPI | 1962993899 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MA DN10000764) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 060567) |
| Enumeration Date | 2018-05-26 |
| Last Update Date | 2025-08-07 |