| NPI | 1992762694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 29295) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD LL606) |
| 1223G0001X Dentist, General Practice (Licence: UT 374350-9923) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2023-04-11 |