| NPI | 1083757330 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 936) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7963) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2013-10-08 |