| NPI | 1447237672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NC 0242) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: WV 2490) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-05-05 |