| NPI | 1164706347 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125K00000X Advanced Practice Dental Therapist (Licence: MN DT69) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WI 11055-016) |
| 124Q00000X Dental Hygienist (Licence: MN H8920) | |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2018-10-25 |