| NPI | 1275680944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 3570) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 3570) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2011-11-03 |