| NPI | 1679632418 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D14399) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: ND 1092) |
| 124Q00000X Dental Hygienist (Licence: MN 7502) | |
| 124Q00000X Dental Hygienist (Licence: CO 905050) | |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2020-07-06 |