| NPI | 1720441041 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D14321) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001328-15) |
| 122300000X Dentist (Licence: IA DDS-09304) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2020-06-17 |