NPI | 1699061473 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 35767) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00203233) |
Enumeration Date | 2011-06-21 |
Last Update Date | 2025-09-09 |