| NPI | 1740639012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 39931) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA 03461920) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2024-03-11 |