| NPI | 1831151505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 22840) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 009350) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2011-05-23 |