| NPI | 1659667343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 8538394-9923) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-151C) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 8538394-8903) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2018-03-17 |