| NPI | 1891248035 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 34412) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 1603) |
| Enumeration Date | 2016-07-24 |
| Last Update Date | 2018-08-06 |