| NPI | 1841795291 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN S161) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901022528) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2021-01-29 |