| NPI | 1932766987 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS043842) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS043842) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2022-11-07 |