| NPI | 1982875472 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 21969) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA DN21969) |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2016-05-28 |