| NPI | 1053362590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 14406) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS036367) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401414156) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2021-08-17 |