| NPI | 1629554498 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D15400) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.031789) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2026-04-06 |