| NPI | 1467427625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 5382) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: NE 5382) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2011-12-19 |