| NPI | 1114623170 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS044187) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 13852) |
| 1223G0001X Dentist, General Practice (Licence: CT 13852) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2025-12-01 |