| NPI | 1053668285 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CT 10902) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856100) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2016-08-24 |