| 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 |