| NPI | 1013204254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 27140) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27140) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2021-06-14 |