| NPI | 1730173295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 5923) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 21063) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 8620) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2009-11-17 |