| NPI | 1043505365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 31781) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 31781) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2020-08-03 |