| NPI | 1992101026 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN03285) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856775) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2015-10-26 |