| NPI | 1821362757 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855875) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: OK 94) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2014-09-16 |