| NPI | 1437114253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS037749) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D5576) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-104C) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2013-07-24 |