| NPI | 1538781224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 11781985-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 11781985-0702) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2023-04-26 |