| NPI | 1639186281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 34762) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 43475) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 43475) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2022-11-09 |