| NPI | 1124435771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401416364) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 33184) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2021-05-25 |