NPI | 1992937353 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 27068) |
Additional Taxonomies | 122300000X Dentist (Licence: LA S572) |
Enumeration Date | 2009-08-19 |
Last Update Date | 2012-04-18 |