| NPI | 1164945150 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13899) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34948) |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2024-12-13 |