| NPI | 1659613479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 9319) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9319) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2019-07-03 |