| NPI | 1548225659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 4107) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4107) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2008-07-16 |