NPI | 1396397634 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 41305) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 41305) |
122300000X Dentist (Licence: NJ 22DI02761700) | |
Enumeration Date | 2019-07-16 |
Last Update Date | 2025-08-03 |