| NPI | 1245461920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 61096) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24732) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2012-06-07 |