| NPI | 1407933740 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1855519) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 9115) |
| 122300000X Dentist (Licence: RI DEN03005) | |
| 122300000X Dentist (Licence: MA DN1855519) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2017-04-27 |