NPI | 1740839828 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 35832) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 35832) |
Enumeration Date | 2019-09-10 |
Last Update Date | 2022-01-27 |