| NPI | 1477112043 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: KY 9684) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9684) |
| 1223P0300X Dentist, Periodontics (Licence: KY 9684) | |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2020-07-20 |