| NPI | 1285861260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401412529) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA ds038620) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2013-05-31 |