| NPI | 1912331265 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125J00000X Dental Therapist (Licence: MN DT28) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MN H5837) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2018-06-21 |