| NPI | 1235417783 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D12994) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6766-015) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2020-12-02 |