| NPI | 1972838159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 29537) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29537) |
| 122300000X Dentist (Licence: OH 30-023121) | |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2020-09-09 |