| NPI | 1285929638 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1855698) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855698) |
| 122300000X Dentist (Licence: MI 2901021767) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2018-01-22 |