| NPI | 1861063497 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 40723) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 7252) |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2025-09-18 |