NPI | 1033398458 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ND 2168) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 6734) |
Enumeration Date | 2007-11-01 |
Last Update Date | 2013-07-10 |