| NPI | 1871775635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 25216) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 5873) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2018-10-12 |