| NPI | 1750896510 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125J00000X Dental Therapist (Licence: MN DT74) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MN H8870) |
| Enumeration Date | 2017-12-02 |
| Last Update Date | 2020-07-16 |