| NPI | 1942664727 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DL12890) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: MA DA07390) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2016-07-22 |