| NPI | 1497921209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 23102) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 23102) |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 23102) | |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2012-02-17 |