| NPI | 1548499742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855488) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL10679) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2010-07-22 |