| NPI | 1902239007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 29367) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29367) |
| 122300000X Dentist (Licence: OK 7133) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 108) | |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2022-11-30 |