| NPI | 1639144140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 23664) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401411093) |
| Enumeration Date | 2006-02-18 |
| Last Update Date | 2012-10-26 |