| NPI | 1659012383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 40408) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 13776) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-04-16 |