| NPI | 1871162669 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D14939) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D14939) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2024-07-14 |