| NPI | 1306059464 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 111136) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MA 7120) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-07-08 |