| NPI | 1487961801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855619) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ DI02453900) |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2011-02-25 |