| NPI | 1497837587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 013063) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 13063) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2012-08-16 |