| NPI | 1942651088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 1086) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9808) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2022-06-29 |