| NPI | 1730442120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D13608) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60537729) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13608) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2025-01-28 |