| NPI | 1447299607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: UT 267453-9922) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: UT 267453-8903) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2007-07-08 |