NPI | 1164688800 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 7030084-9922) |
Additional Taxonomies | 122300000X Dentist (Licence: UT 7030084-9922) |
Enumeration Date | 2008-08-01 |
Last Update Date | 2018-09-21 |