| NPI | 1144803313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS044384) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 108019) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2023-11-27 |