| NPI | 1417364472 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2017029554) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13455) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2026-04-30 |