| NPI | 1154558815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-126C) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D7770) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN00202015) | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2014-03-06 |