| NPI | 1780372797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 111051) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044174) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2026-08-11 |