| NPI | 1477873313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 062206) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN H278001328617) |
| 122300000X Dentist (Licence: MN D13022) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2022-02-01 |