| NPI | 1487070082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 9675961) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 7216-15) |
| Enumeration Date | 2014-03-07 |
| Last Update Date | 2016-07-18 |