| NPI | 1417214396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 15357) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001159) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401413952) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2020-12-15 |