| NPI | 1740456938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 24927) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NY P57308) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2010-02-03 |