| NPI | 1598985285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 15556) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX 15556) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 15556) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |