| NPI | 1801150115 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AL 6222) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: ME DEN4234) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2016-06-28 |