| NPI | 1336423078 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 9126) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9126) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2014-12-12 |