| NPI | 1811446727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 9813262-9923) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 138) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2020-01-09 |