| NPI | 1972366573 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN10000025) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MA DH80900) |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2024-06-07 |