| NPI | 1225172265 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 22138) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 048143-1) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2014-12-12 |