| NPI | 1992026595 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VT 016.0079929) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855479) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2011-09-08 |