| NPI | 1811158124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TN 8825) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 22828) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2008-06-19 |