| NPI | 1588815005 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA 22204) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401413056) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2016-05-11 |