| NPI | 1437250560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401412222) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412222) |
| 1223G0001X Dentist, General Practice (Licence: MN D12307) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2019-06-07 |