| NPI | 1801298617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 33511) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15676) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2017-12-21 |