| NPI | 1144965377 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN R823) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ Student) |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2022-07-26 |