| NPI | 1457589517 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 27360) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12726) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2011-09-21 |