| NPI | 1891215273 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 35032) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2017020498) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2019-09-10 |