| NPI | 1598282154 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-09860) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13904) |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2021-04-08 |