| NPI | 1649432436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 23919) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 9957) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2020-09-03 |