| NPI | 1225463755 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 32140) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9594) |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2021-12-01 |