NPI | 1154738870 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 31751) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN21017) |
Enumeration Date | 2014-07-15 |
Last Update Date | 2023-10-27 |