| NPI | 1508094947 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D12992) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6409-15) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2013-10-03 |