| NPI | 1891075768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VT 0160094415) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA DN1855789) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2015-08-05 |