| NPI | 1538518774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015779) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8938) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA DS040823) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2019-01-07 |