| NPI | 1760978647 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38034) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D14075) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2022-04-15 |