| NPI | 1598020943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 08946) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08946) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2017-01-20 |