| NPI | 1174366553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS045411) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN30910) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2025-12-03 |