| NPI | 1265698815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 8466) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 018.001625) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2010-08-13 |