| NPI | 1003256876 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13459) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2013016299) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2022-11-06 |