| NPI | 1770860157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: MN 04720) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WI 5398016) |
| Enumeration Date | 2011-11-13 |
| Last Update Date | 2018-03-17 |