| NPI | 1730752254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: MN S203) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN S203) |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2024-05-13 |