| NPI | 1851640478 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: MN H4727) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WI 10916-016) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2015-06-25 |