| NPI | 1750435988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 0024331) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60119961) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2017-02-12 |