| NPI | 1326037524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D6332) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2000165443) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 9025376) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2008-10-03 |