| NPI | 1801043138 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1856140) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856140) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2015-03-20 |