| NPI | 1477888410 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 8193) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8193) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2019-11-06 |