| NPI | 1841852902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35255) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 35255) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2021-10-26 |