| NPI | 1790932408 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855059) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57244) |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2009-05-13 |