| NPI | 1578921045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 38289) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 000064) |
| Enumeration Date | 2016-01-29 |
| Last Update Date | 2024-05-13 |