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 |