| NPI | 1962527481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 25351) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30022364) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2011-11-04 |