| NPI | 1134560808 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1857107) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020777) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2017-03-09 |