| NPI | 1528035946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 5515) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 6798) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2007-07-08 |