| NPI | 1912095928 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 24400) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24400) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2014-02-25 |