| NPI | 1104278217 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D14310) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN015238) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2021-03-02 |