| NPI | 1023043205 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN D10533) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD1694) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2016-12-25 |