| NPI | 1912570672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MN D15043) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NE 7750) |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2024-09-04 |