| NPI | 1033670922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 38159) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 5315229232) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-03-30 |