| NPI | 1720355431 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN4241) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023264) |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2012-10-19 |