| NPI | 1750492989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA 000009918) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 38909) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-01-03 |