| NPI | 1962085704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 37665) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 37665) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 37665) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2023-04-05 |