| NPI | 1164977047 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001414-15) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 32681) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2022-07-21 |