| NPI | 1649550260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125J00000X Dental Therapist (Licence: MN DT02) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MN H5961) |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2017-11-14 |