| NPI | 1407135742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D008182) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D008182) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2014-07-01 |