| NPI | 1376708933 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D14051) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9120) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 08796) | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2021-02-10 |