| NPI | 1255567442 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 8760) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 8760) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2021-09-17 |