| NPI | 1164806584 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1857158) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857158) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2016-08-04 |