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 |