NPI | 1225535677 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NC 12625) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS041767) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-04-11 |
Last Update Date | 2022-12-19 |