| NPI | 1427434232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: UT 9401146-9924) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: ND 2432) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2024-05-11 |