| NPI | 1063604924 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: CT 006543) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT E47045) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2007-08-15 |