| NPI | 1477520815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 6092-15) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D11728) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2011-04-12 |