| NPI | 1629296553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 22764) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 08436) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2011-11-02 |