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 |