| NPI | 1497262802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 9948) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KY 9948) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2018-06-06 |