| NPI | 1376754424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: DC DEN1000562) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 16208) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2016-11-14 |