| NPI | 1285103291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 34969) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX ETN526) |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2019-08-19 |