| NPI | 1407801939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-3592-PD) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D3592) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2008-06-05 |