| NPI | 1578042693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D14306) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34311) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2019-10-23 |