| NPI | 1114195112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 14024) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS036891) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2016-04-13 |