| NPI | 1821434978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 28652) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28652) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2023-05-26 |