| NPI | 1417097411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: MN 10021) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: WI 6668-15) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2016-07-19 |