| NPI | 1417006974 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D10273) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN 10273) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-10-29 |