| NPI | 1225207251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NV S6-100) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: AZ D7457) |
| Enumeration Date | 2008-02-24 |
| Last Update Date | 2010-08-18 |