| NPI | 1619435682 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 125K00000X Advanced Practice Dental Therapist (Licence: MN DT83) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MN H9759) |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2020-06-19 |