| NPI | 1780732149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 7141) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: KY 1281) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2011-03-14 |