| NPI | 1770551723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: UT 140796-9922) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NV S6-34C) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2009-06-01 |