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 |