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 |