| NPI | 1326430067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 31002) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31002) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2022-07-21 |