| NPI | 1134559636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 65240) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 29581) |
| 1223G0001X Dentist, General Practice (Licence: TX 29581) | |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2016-03-04 |