| NPI | 1124299193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN17924) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX TX24260) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24260) | |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2011-07-07 |