| NPI | 1114129764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 23214) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 8276) |
| 122300000X Dentist (Licence: TX 23214) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2018-02-13 |