NPI | 1023454071 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 6422) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00201959) |
Enumeration Date | 2013-05-17 |
Last Update Date | 2018-11-16 |