| NPI | 1548530777 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1858278) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MA DH87279) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2019-08-06 |