| NPI | 1124013032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0404000062) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 4784) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 4825) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2014-04-14 |