| 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 |