| NPI | 1194105809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 33165) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-153) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2024-01-04 |