| NPI | 1386688331 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 19077) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 19077) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 19077) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2009-12-11 |