| NPI | 1124408075 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: MA DF11493) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DF11067) |
| 122300000X Dentist (Licence: NY 000114) | |
| 1223X2210X Dentist, Orofacial Pain (Licence: NY 000114) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2020-11-06 |