| NPI | 1467591065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24446) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 052957) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2019-11-19 |