NPI | 1972170405 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 39453) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.033262) |
Enumeration Date | 2021-06-04 |
Last Update Date | 2024-01-30 |