| NPI | 1871747865 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125K00000X Advanced Practice Dental Therapist (Licence: MN DT4) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MN H6785) |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2018-09-10 |