| NPI | 1447776513 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 12263) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 16323) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1858065) | |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2018-08-16 |