| NPI | 1003835711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WI 4121) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MN D10134) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2016-04-27 |