| NPI | 1508207994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 30815) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856322) |
| 122300000X Dentist (Licence: TX 30815) | |
| Enumeration Date | 2013-07-13 |
| Last Update Date | 2019-04-15 |