| NPI | 1275971152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 28220) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28220) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2014-07-11 |