| NPI | 1154556561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D12909) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855129) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2014-10-02 |