| 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 | 2018-08-24 |