| NPI | 1164719126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN S41) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 55971) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2016-11-28 |