| NPI | 1437316015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401412764) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 8583) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2010-06-03 |