| NPI | 1598507097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS044591) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: PA DS044591) |
| Enumeration Date | 2024-06-07 |
| Last Update Date | 2024-07-31 |