| NPI | 1174685291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS035797) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 13822) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2016-12-15 |