| NPI | 1306071048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24602) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24602) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2018-04-12 |