| NPI | 1245588656 |
|---|---|
| Former Name | DIANA MARIE BURNHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: NM DH2439) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CA 20684) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2012-08-16 |