| NPI | 1356836761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 12835) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D14009) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2022-07-25 |