| NPI | 1689231078 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D14220) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D14220) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2022-07-19 |