| NPI | 1568692663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 009425) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 009425) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2009-07-23 |