| NPI | 1558961003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D14529) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN R776) |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2021-07-01 |