| NPI | 1487854808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: GA DNO13520) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: VA 442000064) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2012-04-27 |