| NPI | 1407907769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: SC 248) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: SC 2299) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |