| NPI | 1164869343 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13965) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9495) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901020934) | |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2020-08-24 |