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 |