| NPI | 1821381765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1855705) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NH 03860) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2015-01-16 |