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 |