| NPI | 1902258437 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33312) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS040920) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2022-06-29 |