| NPI | 1457697591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC den3272) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: DC den3272) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: DC den3272) | |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2012-12-18 |