| NPI | 1578949632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 31494) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857005) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2016-03-31 |