| NPI | 1518468099 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VT 016.0133993) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DF11267) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2022-02-22 |