| NPI | 1013909381 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN S37) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 8785) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 6651) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2012-02-21 |