NPI | 1699737825 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 33675) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30022122) |
Enumeration Date | 2006-04-04 |
Last Update Date | 2023-07-14 |