| NPI | 1548389802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 17210) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MA 17210) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |