| NPI | 1255895124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125J00000X Dental Therapist (Licence: MN DT115) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MN H10571) |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2020-12-13 |