| NPI | 1477715514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D12528) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN 12528) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2012-11-26 |