| NPI | 1497961338 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 5743) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 60453) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |