| NPI | 1841781754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02723200) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041690) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2018-09-08 |