| NPI | 1093194763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13591) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D13591) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2017-11-29 |