| NPI | 1164150215 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D15167) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6001055-15) |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2024-12-16 |