| NPI | 1598076119 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13461) |
| Additional Taxonomies | 122300000X Dentist (Licence: ND 2232) |
| 122300000X Dentist (Licence: MO 2011039028) | |
| 1223G0001X Dentist, General Practice (Licence: WI 6507) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2022-01-07 |