| NPI | 1962840512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1856733) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057507) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2014-11-13 |