| NPI | 1013408608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA RFD000051) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 12283) |
| Enumeration Date | 2018-05-20 |
| Last Update Date | 2022-04-19 |