| NPI | 1396848438 |
|---|---|
| Former Name | ETHEL MARIA CAMPOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: TX 12345) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: VA 0402203093) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2007-07-08 |