| NPI | 1821249798 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 34262) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57607) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2019-11-21 |