| NPI | 1003041328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 14345) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: DC DEN1000816) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401412530) | |
| Enumeration Date | 2009-05-17 |
| Last Update Date | 2016-01-28 |