| NPI | 1134285455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MS 3116) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TN 4237) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2007-07-08 |