| NPI | 1669775979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: MI 2902003818) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: MI 2903000741) |
| Enumeration Date | 2010-12-08 |
| Last Update Date | 2010-12-08 |