| NPI | 1871652354 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 1855276) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 7194) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2011-11-10 |