| NPI | 1740556505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1856244) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI DEN03188) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2013-09-06 |