| NPI | 1528124559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D5802) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 51931) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 21208) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2007-07-08 |