| NPI | 1053562413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24197) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24197) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2018-02-21 |