| NPI | 1285958074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MN D13046) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901020159) |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2016-10-05 |