| NPI | 1184700486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE 60116118) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI 02271700) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 21838) | |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2015-11-02 |