| NPI | 1609206135 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 11700) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856427) |
| 122300000X Dentist (Licence: NJ 22DI02497200) | |
| 122300000X Dentist (Licence: PA DS039775) | |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2016-10-17 |