NPI | 1205980414 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 08289) |
Additional Taxonomies | 122300000X Dentist (Licence: IA 08289) |
Enumeration Date | 2007-01-23 |
Last Update Date | 2009-10-14 |