| NPI | 1164411468 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 582) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 6688) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2012-02-21 |