| NPI | 1053829721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 125J00000X Dental Therapist (Licence: MN 88) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MN 10012) |
| Enumeration Date | 2018-01-16 |
| Last Update Date | 2018-01-16 |