NPI | 1447371943 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SD D0976) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 6547) |
1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2007022319) | |
Enumeration Date | 2007-04-02 |
Last Update Date | 2015-12-28 |