| NPI | 1619350006 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13579) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D13579) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2025-12-16 |