| NPI | 1568775591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: AZ D008923) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS038997) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2015-04-23 |