| NPI | 1356359004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 21176) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NC 8238) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2007-07-08 |