| NPI | 1174818066 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MA DN1855702) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855702) |
| 122300000X Dentist (Licence: OH RES.3114) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2013-06-24 |