| NPI | 1548502206 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13465) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 7174-15) |
| 1223G0001X Dentist, General Practice (Licence: CA 62134) | |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2015-03-27 |