| NPI | 1285945089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MN D12836) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 26295) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2016-10-19 |