| NPI | 1962522714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: UT 3432899922) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: UT 3432898903) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |