| NPI | 1487644852 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: RI DEN03075) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD2623) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2010-05-18 |