NPI | 1265735542 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 62070) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 50054647) |
Enumeration Date | 2010-12-08 |
Last Update Date | 2013-02-08 |