| NPI | 1043275548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 003955) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CT 003955) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2007-07-11 |