| NPI | 1093209181 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D14153) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09542) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2019-07-26 |