| NPI | 1770627358 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 21455) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME 3795) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2013-08-02 |