| NPI | 1043352412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 7460) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411545) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2009-08-07 |