| NPI | 1649805664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS042915) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS042915) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 10734) | |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2024-07-10 |