| NPI | 1306258967 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 31674) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31674) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 122300000X Dentist (Licence: CA 100026) | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2016-06-28 |