| NPI | 1649487737 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 22319) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 22319) |
| 122300000X Dentist (Licence: NY 053726-1) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2014-09-09 |