| NPI | 1396751475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR d6558) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA deoooo6891) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |