| NPI | 1083720114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ND 1995) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12309) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2017-02-11 |