| NPI | 1033495510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: DE G1-0001430) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 27526) |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2022-06-09 |