| NPI | 1487949053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NC 9926) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9019) |
| 1223P0300X Dentist, Periodontics (Licence: NC 260121) | |
| Enumeration Date | 2011-06-12 |
| Last Update Date | 2015-06-30 |