| NPI | 1245677905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 6519119) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA ds039508) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00202509) | |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2021-04-08 |