| NPI | 1881186625 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13995) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN D13995) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2018-11-28 |