| NPI | 1326577636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13848) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: MN D13848) |
| 1223P0700X Dentist Prosthodontics (Licence: NE 7765) | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2023-09-08 |