| NPI | 1720431406 |
|---|---|
| Former Name | KATELYN TOBALSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10590) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 151094) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2022-12-05 |