| NPI | 1467560490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC ID0020) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 801) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2008-05-15 |