| NPI | 1245542059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 9667) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME 4149) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2018-09-06 |