NPI | 1306158886 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 26463) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 26463) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2010-07-13 |
Last Update Date | 2023-07-06 |