| NPI | 1821392457 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: IA 2062) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 5587) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2019-05-20 |