| NPI | 1245787795 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: FL DH14876) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: PA DH009975L) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |