| NPI | 1053735993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 29973) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29973) |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2016-07-09 |