| NPI | 1982858981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 26032) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60907) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2018-10-11 |