| NPI | 1679801062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA 165342) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FM 003661) |
| Enumeration Date | 2009-11-24 |
| Last Update Date | 2009-11-24 |