| NPI | 1457807760 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: FL DH20699) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MI 2902003339) |
| 124Q00000X Dental Hygienist (Licence: NC 7512) | |
| Enumeration Date | 2016-08-27 |
| Last Update Date | 2016-08-27 |