| NPI | 1730442120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MN D13608) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: MN D13608) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: WA DE60537729) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2023-02-15 |