| NPI | 1821093048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 29022) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 2560) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2013-09-24 |