| NPI | 1033192398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 040110496) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 051082) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2012-05-03 |