| NPI | 1811475643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 34503) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34503) |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2020-06-29 |