| NPI | 1316335250 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 1857218) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 64268) |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2017-01-31 |