| NPI | 1528441565 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN S204) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6876) |
| 1223G0001X Dentist, General Practice (Licence: TX 31144) | |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2025-07-30 |