| NPI | 1982638359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 22042) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 80) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2016-03-07 |