| NPI | 1265652481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D4330) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NM DD1995) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2007-07-09 |