| NPI | 1639175748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 56989) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 22134) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2016-09-19 |