| NPI | 1508130253 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29605) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 29605) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2021-06-15 |