| NPI | 1255589164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 7108173-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7108173-9921) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2014-04-03 |