| NPI | 1821309543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VT 016.0104972) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY NYS 055499) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2014-09-09 |