| NPI | 1366621120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 23632) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 23632) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2011-12-27 |