| NPI | 1790224301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: NH 02779) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MA 13985) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2017-02-15 |