| NPI | 1487333845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 40196) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: CA 106399) |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2024-02-20 |