| NPI | 1306140132 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL11558) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL10947) |
| 1223G0001X Dentist, General Practice (Licence: MA DL10947) | |
| 122300000X Dentist (Licence: MA DL11279) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2012-09-04 |