| NPI | 1811737950 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 41942) | 
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401418766) | 
| Enumeration Date | 2024-05-28 | 
| Last Update Date | 2025-10-30 |