| NPI | 1366598880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: WA DE00010610) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 21889) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2012-02-29 |