| NPI | 1407308661 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 060965) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857436) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2020-06-15 |