| NPI | 1063818672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 11491) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856772) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2015-09-24 |