| NPI | 1063266997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 14251849-9925) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-250C) |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2026-08-31 |