| NPI | 1750506432 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DN1856473) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 051991) |
| 122300000X Dentist (Licence: MA DN1856473) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2014-09-05 |