| NPI | 1912989302 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 4717) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 4717) |
| Enumeration Date | 2005-11-19 |
| Last Update Date | 2009-07-15 |