| NPI | 1184914988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MD 17014) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: MD LL770) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2020-07-16 |