| NPI | 1497905681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN014127) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 5930) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2010-07-19 |