| NPI | 1154988103 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 10252) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10252) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12013337A) | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2021-10-20 |