| NPI | 1164086807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D14186) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30678) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2026-06-19 |