| NPI | 1811340409 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13697) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0133924) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2025-01-21 |