| NPI | 1245248996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 0005) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WV 2405) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: AL 3987) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2014-02-19 |