| NPI | 1710137427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 22107) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 53689) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2014-03-27 |