| NPI | 1710250873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 35024) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN22760) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2020-10-09 |