| NPI | 1174768931 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DL10511) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 04176) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2015-08-10 |