| NPI | 1831546704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13784) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021833) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2017-04-19 |