| NPI | 1114137478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS036279) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS036279) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2018-09-13 |