| NPI | 1033274907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 21571) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 21069) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2007-11-14 |