| NPI | 1275607053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WV 2131 Specialty 17) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401008536) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN10837) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |