| NPI | 1326180308 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND12610) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL 18300) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2025-01-16 |