| NPI | 1477780286 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855342) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 28816) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2014-06-17 |