| NPI | 1023068038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 14580) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 14580) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2024-09-23 |