| NPI | 1437171584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NC 0023) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 8083) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: CA 21748) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: DC DEN157) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2014-01-31 |