| NPI | 1740536622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 28300) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 28300) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2022-07-05 |