| NPI | 1043401367 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D11875) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411671) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2014-08-14 |