| NPI | 1124152632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D11958) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019-026815) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2012-03-12 |