| NPI | 1083909535 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855713) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001367) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2017-05-03 |