| NPI | 1477843936 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D13120) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 6800-15) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2021-01-20 |