| NPI | 1063893808 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 31036) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31036) |
| 1223G0001X Dentist, General Practice (Licence: TX 31036) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2021-10-08 |