| NPI | 1073772299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D9489) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D7527) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2011-06-14 |