| NPI | 1588762520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: VA 0402004748) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MD 4592) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2013-08-15 |