| NPI | 1114077872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS-025969L) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: OH 30-02-0258) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-07-09 |