| NPI | 1891246328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 32155) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32155) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.026239) | |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2023-08-17 |