| NPI | 1043494875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AK 983) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 12505) |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2007-12-28 |