| NPI | 1902229552 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 32509) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI 224) |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2018-01-05 |