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 |