| NPI | 1174811871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 31797) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00202066) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2016-04-19 |