| NPI | 1790088979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 125J00000X Dental Therapist (Licence: MN DT155) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MN D8546) |
| Enumeration Date | 2010-12-10 |
| Last Update Date | 2023-09-08 |