| NPI | 1700034121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: TN 47306) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: TN 05887) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2008-08-29 |