| NPI | 1477123420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D15183) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 09935) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2026-01-13 |