| NPI | 1073828620 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13627) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020280) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2019-08-01 |