| NPI | 1104205772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN4422) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: ME DEN4422) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2016-10-26 |