| NPI | 1003014614 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL12853) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL12854) |
| 122300000X Dentist (Licence: MA DL12884) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2017-02-16 |