| NPI | 1205190022 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 11364) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI LD00076) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2015-08-24 |