| NPI | 1457474835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 25589) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 21493) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2010-08-26 |