NPI | 1487749271 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS038622) |
Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DS038622) |
1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401410191) | |
Enumeration Date | 2006-10-04 |
Last Update Date | 2024-09-05 |