| NPI | 1619302353 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DL12012) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NV 6797) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2016-11-23 |