| NPI | 1548676349 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 9459) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9459) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2016-09-23 |