| NPI | 1659758423 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: CT 008073) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MA DH88283) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2015-04-30 |