| NPI | 1053550400 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: AK 165) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: KY 8427) |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2009-11-17 |