| NPI | 1457468217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2010015736) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 8394) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2010-08-11 |