| NPI | 1609138460 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 28521) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 28521) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2024-03-29 |