| NPI | 1386975258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 31052) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31052) |
| 1223G0001X Dentist, General Practice (Licence: AZ D7540) | |
| Enumeration Date | 2010-01-16 |
| Last Update Date | 2017-09-05 |