| NPI | 1013381425 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D13645) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN R615) |
| 122300000X Dentist (Licence: FL DN21507) | |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2019-10-03 |