| NPI | 1467659623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D12756) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08474) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2010-06-29 |