| NPI | 1437264538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D8232) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 20435) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-08 |