| NPI | 1568024453 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 10057) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401418114) |
| 1223P0300X Dentist, Periodontics (Licence: VA 0401418114) | |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2024-12-09 |