| NPI | 1629046743 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D11685) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 5600015) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2015-05-21 |