| NPI | 1154949915 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 13181) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36218) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2025-09-01 |