| NPI | 1184856320 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D13034) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1855297) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2012-01-24 |