| NPI | 1598830291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 144270-8903) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 14270-9921) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-07-08 |