| NPI | 1306977574 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 8044) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 8044) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2013-06-12 |