| NPI | 1568877504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1856552) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 11184) |
| Enumeration Date | 2014-06-29 |
| Last Update Date | 2014-06-29 |