| NPI | 1689821621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 38263) |
| Additional Taxonomies | 122300000X Dentist (Licence: ND 2316) |
| 122300000X Dentist (Licence: MI 2901019872) | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2022-05-22 |