| NPI | 1124120191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 14165) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411486) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2011-12-06 |