| NPI | 1780706275 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D12483) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D12483) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2004013591) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2023-06-20 |