| NPI | 1366130874 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125K00000X Advanced Practice Dental Therapist (Licence: MN DT162) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MN H11401) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2025-03-24 |