| NPI | 1518024587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: HI DT 2038) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 47826) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2009-03-11 |