| NPI | 1326260035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA de00010088) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D8681) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-09 |