| NPI | 1982915500 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 25597) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25597) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2018-08-28 |