| NPI | 1326105602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OR D-9698) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 054845-1) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: CA 52784) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: WA DE00009973) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2015-09-22 |