| NPI | 1649287434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 20492) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 20492) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 20492) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 20492) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2007-07-09 |