| NPI | 1194038745 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401412978) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA NO LICENSE) |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2018-11-15 |