| NPI | 1710386651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1856689) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI DEN03282) |
| Enumeration Date | 2014-08-16 |
| Last Update Date | 2017-06-13 |