NPI | 1003005547 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401411673) |
Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411673) |
Enumeration Date | 2007-10-22 |
Last Update Date | 2011-02-15 |