| NPI | 1679730683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24217) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS037740) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2010-03-30 |