| NPI | 1841642154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 35784) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3884-16) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2022-08-23 |