| NPI | 1811389588 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 203074) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 31454) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2020-09-14 |