| NPI | 1013952266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 21135) |
| Additional Taxonomies | 1223X2210X Dentist Orofacial Pain (Licence: TX 21135) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2023-07-25 |