| NPI | 1174665111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OK 7080) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 12145) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: AR 3800) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2023-08-17 |