| NPI | 1225634850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 41282) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 063194) |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2025-04-21 |