| NPI | 1194886622 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 21342) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21342) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2010-03-11 |