| NPI | 1477862076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WY 1271) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 76935609922) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2020-02-10 |