| NPI | 1982052973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: WA de60753341) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13674) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2021-12-20 |