| NPI | 1740890953 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D14686) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36461) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2022-04-21 |