| NPI | 1053545665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 26442) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 3732) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2011-06-13 |