| NPI | 1063889954 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN d13966) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 058226) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2020-08-10 |