| NPI | 1760643696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WY 1282) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 202134) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 0025605) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2023-03-02 |