| NPI | 1194238956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 38358) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10038) |
| 1223G0001X Dentist, General Practice (Licence: KY 10038) | |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2022-09-28 |