| NPI | 1093799819 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: KY 5693) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 5693) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2014-01-09 |