NPI | 1487709556 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 19638) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 19638) |
Enumeration Date | 2007-01-25 |
Last Update Date | 2021-05-24 |