| NPI | 1831322668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24908) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24908) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2024-04-16 |