| NPI | 1457794315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 8610890) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 8610890-9923) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2024-02-05 |