| NPI | 1114451150 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN A8428) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: MN A8428) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2017-04-17 |