| NPI | 1821724394 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125K00000X Advanced Practice Dental Therapist (Licence: MN DT062) |
| Additional Taxonomies | 125J00000X Dental Therapist (Licence: MN DT062) |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2024-04-03 |