| NPI | 1417943093 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MN D12092) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 41346) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2025-09-23 |