| NPI | 1447214820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 12091) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: MD 12091) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2012-04-05 |