| NPI | 1164619318 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 19522) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 19522) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2008-11-06 |