| NPI | 1407011513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 6781) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6781) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2012-12-03 |