| NPI | 1699103572 |
|---|---|
| Former Name | JUSTINA MARIE D'AGOSTINI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901020861) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020861) |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2014-02-03 |