| NPI | 1265883029 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-09804) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13723) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2020-08-05 |