| NPI | 1932546389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OK 100) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 28926) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2016-05-17 |