| NPI | 1174834030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MA DN1856107) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223P0221X Dentist Pediatric Dentistry (Licence: CT 010521) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2016-12-11 |