| NPI | 1164737540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 25850) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV 6282) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2014-08-21 |