| 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 |