| NPI | 1902954258 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: FL DH9503) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL1777) |
| 163W00000X Registered Nurse (Licence: FL RN9307829) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2014-08-08 |