| NPI | 1053549162 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24555) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 0024555) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 024555) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2021-06-11 |