| NPI | 1649426560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24870) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 56477) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 059560) | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2018-12-05 |