| NPI | 1356328041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24272) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS037459) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2009-05-04 |