| NPI | 1467892802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29218) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 29218) |
| Enumeration Date | 2013-06-30 |
| Last Update Date | 2016-03-23 |