| NPI | 1134567308 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN03220) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856636) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2017-03-24 |