| NPI | 1942634597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13318) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 715815) |
| Enumeration Date | 2013-08-30 |
| Last Update Date | 2014-05-05 |