| NPI | 1265744098 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855751) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL11001) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2011-07-13 |