| NPI | 1598735730 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 25056) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 11929) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2009-10-14 |