| NPI | 1528424876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D009373) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009373) |
| Enumeration Date | 2016-01-01 |
| Last Update Date | 2017-06-08 |