| NPI | 1639126683 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D11365) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 6666-015) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2011-10-19 |