| NPI | 1891174629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DN1856822) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15293) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2019-09-27 |