| NPI | 1205315538 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 38105) |
| Additional Taxonomies | 122300000X Dentist (Licence: ZZ 9414) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2025-05-05 |