| NPI | 1457792368 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1856679) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 20608) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2015-09-15 |