| NPI | 1104302124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN 14131) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN1001884) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2024-09-16 |