| NPI | 1659615334 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1856084) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414232) |
| 122300000X Dentist (Licence: NH 03850) | |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2014-09-03 |