| NPI | 1710392147 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 31678) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31678) |
| 122300000X Dentist (Licence: PA DS040316) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2016-06-27 |