| NPI | 1184299737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 5979696-9923) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 5979696-9923) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA DDS108670) | |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2024-11-25 |