| NPI | 1063418085 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MA 19265) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 19265) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2008-01-30 |