| NPI | 1417130667 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D12589) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.025038) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2009-09-14 |