| NPI | 1760880355 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CT 12366) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: ME FDN5) |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2018-10-01 |