| NPI | 1861796013 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13489) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6637-15) |
| 1223G0001X Dentist, General Practice (Licence: IA 08637) | |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2019-04-19 |